Geriatric Medical Assessments

As a caregiver, if you notice that your parent does not seem to be functioning as well as she/he has functioned in the past, your natural response is probably to contact your elder's primary physician. Most of the time, this doctor can provide the care your elder needs, or will refer him/her to someone who can. Sometimes, however, sending your elder to many specialists can result in a fragmented medical view of your elder. Each doctor may form a limited, inaccurate picture of your elder's health, causing misdiagnosis or negative drug interactions.

If you suspect that this is the case, or if your elder already has a history of psychiatric and/or psychological problems combined with other medical needs, you may wish to explore resources for a complete geriatric medical assessment.

What Is a Geriatric Medical Assessment?

This evaluation may involve at minimum a doctor and a registered nurse, but a truly comprehensive assessment may include: a social worker, neurologist, psychiatrist, cardiologist, gastroenterologist, rheumatologist, and/or a physiatrist (physician of rehabilitation medicine). The older adult who undergoes a geriatric medical assessment has the benefit of a more thorough evaluation (including medical and psychological needs), as opposed to an evaluation performed by a specialist focusing on only one aspect of your elder's overall well-being. You, as a caregiver, will then receive a comprehensive summary from the geriatric team, along with specific recommendations for follow-up. Geriatric medical assessments are usually done on an outpatient basis.

What Does the Evaluation Include?

• A geriatric medical assessment may include:
• An evaluation of all medications your elder takes.
• A complete medical history of your elder and close relatives.
• A complete physical examination.
• A neurological examination and evaluation of your elder's mental status.
• Laboratory tests, including blood tests, metabolic screenings, urinalysis, electrocardiogram (EKG), and/or chest X-ray.

If the elder has dementia (memory loss, confusion, disorientation), the assessment may include:

• A psychiatric evaluation to exclude psychiatric disorders.
• An electroencephalogram (EEG).
• A computerized scan of the brain (CAT scan) or Magnetic Resonance Imaging (MRI).
• Neuropsychological tests.
• A lumbar puncture (spinal tap) if infection is suspected.

When Is A Geriatric Medical Assessment Necessary?

You may consider seeking a geriatric medical assessment for your elder if:

• Your elder is considering relocation and you're unsure of the level of care s/he may need. A full evaluation can ensure that she/he selects the right housing arrangement to meet his/her present and (possible) future needs.
• Your elder's doctor dismisses his/her ailments as "old age"; pain, depression, dizziness, incontinence, and memory loss are not normal parts of aging, and thus should be carefully evaluated for possible medical causes.
• Your elder is having difficulty with activities of daily living (i.e., walking, toileting, eating, grooming, dressing) or instrumental activities of daily living (i.e., cooking, shopping, managing medication, doing housework).
• Your elder is experiencing serious memory loss or behavioral changes. While Alzheimer's Disease or a series of small strokes may be the cause, prescription side effects, psychological disorders, or substance abuse may also produce similar symptoms.
• Your elder's doctor makes a diagnosis without doing any testing. For example, she/he diagnoses Alzheimer's Disease without first eliminating other possible causes of memory loss.
• Your elder experiences many ailments that seem to have no cause. There may be an underlying medical condition or psychological problem at the root.

Finding a Geriatric Medical Assessment Team

The availability of this kind of medical evaluation varies regionally. Many large hospitals, medical centers, and research centers offer geriatric medical assessments. A metropolitan area may have several programs from which to choose, while a rural community may have only one center to serve a wide area, or none at all. Your elder may or may not need a referral from his/her primary physician to qualify. In some locations, your elder may have to wait several weeks for an appointment to become available.

Gaining Your Elder's Cooperation

Even when you sense that your elder needs the comprehensive evaluation of a geriatric medical assessment, your elder may resist discussing this possibility. S/he may be fearful of the diagnosis or reluctant to undergo the scrutiny of a medical team. If your elder seems reluctant, you'll probably want to accompany him/her to make the experience less intimidating. Your steadying presence may help to overcome any nonspecific worries or fears. If your elder's resistance persists, you may be able to secure his/her cooperation through involvement of another trusted family member or friend.

If your elder has planned any major changes or events, s/he may be more amenable to an evaluation. For example, if your elder is planning a move to an apartment or a long visit to a relative across the country, a geriatric medical assessment may seem like a reasonable precaution.

If your elder has expressed reluctance to undergo an evaluation for any specific symptom, you may want to wait until s/he expresses a complaint him/herself. If you suggest a geriatric medical assessment as a response to your elder's mild arthritis or headaches, you may also gain his/her cooperation for a comprehensive evaluation, including mental and psychological assessments as well.

Interpreting Recommendations

Ideally, once you and your elder have decided to seek an evaluation, you might want to be present for the appointment (or arrange for another involved family member to do so). This will reassure your elder, and give you access to all necessary information. As a family caregiver, you'll want to help process any feedback and follow through on recommendations. This is especially important if your elder is experiencing memory loss or behavioral changes. Be sure you find out the following information:

• What diagnosis do the professionals on the team make? What treatment do they recommend?
• What does this mean in layman's terms?
• What care, supervision, or changes in the home or routine will your elder need?
• What is your elder's level of functioning and physical health?
• What is his/her mental competency? Can she/he still make decisions for him/herself?
• Will your elder's problem become worse, or will it stay the same? Are any conditions reversible?
• What signs of improvement or decline in health should you and your elder look for? When should you or your elder seek more help?
• What kind of counseling and supportive services are available for your elder and you, the caregiver?

If a social worker is part of your elder's medical team, you may be able to access more follow-up services, often including counseling and referrals to resources and services in your elder's community.

Paying for the Assessment

While the multi-disciplinary expertise and testing in a geriatric medical assessment can be costly, Medicare covers much of the expense. Most programs also accept Medicaid and third party insurance to pay for lab work or testing costs that Medicare may not cover.

If cost is a concern for your elder, look for a medical program that charges on a sliding-fee scale. If your elder is an eligible veteran, some veteran's hospitals offer screenings at no cost.

Your Elder's Future Health

After the geriatric medical assessment, you'll want to help your elder maintain and monitor his/her health. Remember that your elder is an expert on his/her own well-being. No one knows how s/he feels, emotionally and physically, except your elder, so stay attuned to how s/he is feeling.

Encourage your elder to create an active partnership with his/her doctor. Many older adults have grown up believing that doctors shouldn't be questioned. In truth, an effective physician-patient relationship consists of communication on both sides; talking, listening, and questioning. By staying in close contact, your elder will ensure that the medical treatment s/he receives is effective for his/her medical needs.

For more information or a list of other MFS Heritage Planning educational materials on helping your parents, contact your financial adviser.

For more information or a list of other MFS Heritage Planning educational materials on helping your parents, contact your financial adviser.

This material is not intended to replace the advice of a qualified attorney, tax adviser, financial adviser, or insurance agent. Before making any financial commitment regarding the issues discussed here, consult with the appropriate professional adviser. This material was prepared by The Partnership Group; accordingly TPG ( not MFS Fund Distributors,Inc.) is solely responsible for the accuracy of the content.

© 1997 The Partnership Group, Inc.
MFS Fund Distributors, Inc.,<br>
500 Boylston St., Boston, MA 02116

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